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Schmitz KS, Lange MV, Gommers L, Handrejk K, Porter DP, Alabi CA, Moscona A, Porotto M, de Vries RD, de Swart RL. Repurposing an In Vitro Measles Virus Dissemination Assay for Screening of Antiviral Compounds. Viruses 2022; 14:v14061186. [PMID: 35746658 PMCID: PMC9230603 DOI: 10.3390/v14061186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Measles virus (MV) is a highly contagious respiratory virus responsible for outbreaks associated with significant morbidity and mortality among children and young adults. Although safe and effective measles vaccines are available, the COVID-19 pandemic has resulted in vaccination coverage gaps that may lead to the resurgence of measles when restrictions are lifted. This puts individuals who cannot be vaccinated, such as young infants and immunocompromised individuals, at risk. Therapeutic interventions are complicated by the long incubation time of measles, resulting in a narrow treatment window. At present, the only available WHO-advised option is treatment with intravenous immunoglobulins, although this is not approved as standard of care. Antivirals against measles may contribute to intervention strategies to limit the impact of future outbreaks. Here, we review previously described antivirals and antiviral assays, evaluate the antiviral efficacy of a number of compounds to inhibit MV dissemination in vitro, and discuss potential application in specific target populations. We conclude that broadly reactive antivirals could strengthen existing intervention strategies to limit the impact of measles outbreaks.
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Affiliation(s)
- Katharina S. Schmitz
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
| | - Mona V. Lange
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
| | - Lennert Gommers
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
| | - Kim Handrejk
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
| | | | - Christopher A. Alabi
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14850, USA;
| | - Anne Moscona
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA; (A.M.); (M.P.)
- Center for Host–Pathogen Interaction, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Physiology and Cellular Biophysics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matteo Porotto
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA; (A.M.); (M.P.)
- Center for Host–Pathogen Interaction, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Rory D. de Vries
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
| | - Rik L. de Swart
- Department of Viroscience, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (K.S.S.); (M.V.L.); (L.G.); (K.H.); (R.D.d.V.)
- Correspondence:
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2
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Papetti L, Amodeo ME, Sabatini L, Baggieri M, Capuano A, Graziola F, Marchi A, Bucci P, D’Ugo E, Kojouri M, Gioacchini S, Marras CE, Nucci CG, Ursitti F, Sforza G, Ferilli MAN, Monte G, Moavero R, Vigevano F, Valeriani M, Magurano F. Subacute Sclerosing Panencephalitis in Children: The Archetype of Non-Vaccination. Viruses 2022; 14:v14040733. [PMID: 35458463 PMCID: PMC9029616 DOI: 10.3390/v14040733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/22/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late complication of measles virus infection that occurs in previously healthy children. This disease has no specific cure and is associated with a high degree of disability and mortality. In recent years, there has been an increase in its incidence in relation to a reduction in vaccination adherence, accentuated by the COVID-19 pandemic. In this article, we take stock of the current evidence on SSPE and report our personal clinical experience. We emphasise that, to date, the only effective protection strategy against this disease is vaccination against the measles virus.
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Affiliation(s)
- Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
- Correspondence: (L.P.); (F.M.)
| | - Maria Elisa Amodeo
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Letizia Sabatini
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Melissa Baggieri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Alessandro Capuano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Federica Graziola
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Antonella Marchi
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Paola Bucci
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Emilio D’Ugo
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Maedeh Kojouri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Silvia Gioacchini
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Carlo Efisio Marras
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Carlotta Ginevra Nucci
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Gabriele Monte
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Romina Moavero
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Fabio Magurano
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
- Correspondence: (L.P.); (F.M.)
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Peart Akindele N. Updates in the Epidemiology, Approaches to Vaccine Coverage and Current Outbreaks of Measles. Infect Dis Clin North Am 2022; 36:39-48. [DOI: 10.1016/j.idc.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Hashimoto K, Hosoya M. Advances in Antiviral Therapy for Subacute Sclerosing Panencephalitis. Molecules 2021; 26:molecules26020427. [PMID: 33467470 PMCID: PMC7830519 DOI: 10.3390/molecules26020427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late-onset, intractable, and fatal viral disease caused by persistent infection of the central nervous system by a mutant strain of the measles virus. Ribavirin intracerebroventricular therapy has already been administered to several SSPE patients in Japan based on fundamental and clinical research findings from our group, with positive therapeutic effects reported in some patients. However, the efficacy of this treatment approach has not been unequivocally established. Hence, development of more effective therapeutic methods using new antiviral agents is urgently needed. This review describes the current status of SSPE treatment and research, highlighting promising approaches to the development of more effective therapeutic methods.
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Mangia SH, Moraes LF, Takahira RK, Motta RG, Franco MM, Megid J, Silva AV, Paes AC. Efeitos colaterais do uso da ribavirina, prednisona e DMSO em cães naturalmente infectados pelo vírus da cinomose. PESQUISA VETERINARIA BRASILEIRA 2014. [DOI: 10.1590/s0100-736x2014000500011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
O estudo tem o objetivo de identificar efeitos indesejáveis da ribavirina, prednisona e DMSO em cães naturalmente infectados com o vírus da cinomose. Foram utilizados 60 cães apresentando quadro neurológico da cinomose com evolução de 10 dias. Os animais foram internados e receberam tratamento de suporte; foram avaliados diariamente e realizados hemograma, dosagem bioquímica e exame de urina tipo I. Os grupos 1 e 2 foram tratados com ribavirina e sua associação com DMSO; os grupos 3 e 4 com DMSO e prednisona e o grupos 5 com ribavirina e prednisona e o grupo 6 com ribavirina, prednisona e DMSO. Os animais foram anestesiados para a colheita de líquor, medula óssea e sangue, antes do tratamento para diagnóstico através da RT-PCR. As amostras negativas foram analisadas pela técnica de hn-PCR. Todos os animais apresentaram resultado positivo em pelo menos uma das duas reações. O efeito adverso da ribavirina e a sua associação com a prednisona foi a anemia hemolítica, que foi confirmada pela observação de bilirrubina na urina apenas dos cães tratados com ribavirina.
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6
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Tatlı B, Ekici B, Özmen M. Current therapies and future perspectives in subacute sclerosing panencephalitis. Expert Rev Neurother 2014; 12:485-92. [DOI: 10.1586/ern.12.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Hasegawa S, Mori N, Satomi M, Jiang DP, Hotta H, Matsushige T, Ichiyama T. Interferon production by cells infected with subacute sclerosing panencephalitis (SSPE) virus or measles virus. Cytokine 2011; 56:676-9. [DOI: 10.1016/j.cyto.2011.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/10/2011] [Accepted: 09/02/2011] [Indexed: 01/30/2023]
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Abstract
Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis occurring after infection with measles virus. The prevalence of the disease varies depending on uptake of measles vaccination, with the virus disproportionally affecting regions with low vaccination rates. The physiopathology of the disease is not fully understood; however, there is evidence that it involves factors that favour humoral over cellular immune response against the virus. As a result, the virus is able to infect the neurons and to survive in a latent form for years. The clinical manifestations occur, on average, 6 years after measles virus infection. The onset of SSPE is insidious, and psychiatric manifestations are prominent. Subsequently, myoclonic seizures usually lead to a final stage of akinetic mutism. The diagnosis is clinical, supported by periodic complexes on electroencephalography, brain imaging suggestive of demyelination, and immunological evidence of measles infection. Management of the disease includes seizure control and avoidance of secondary complications associated with the progressive disability. Trials of treatment with interferon, ribavirin, and isoprinosine using different methodologies have reported beneficial results. However, the disease shows relentless progression; only 5% of individuals with SSPE undergo spontaneous remission, with the remaining 95% dying within 5 years of diagnosis.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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9
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Vignuzzi M, Stone JK, Andino R. Ribavirin and lethal mutagenesis of poliovirus: molecular mechanisms, resistance and biological implications. Virus Res 2005; 107:173-81. [PMID: 15649563 DOI: 10.1016/j.virusres.2004.11.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Positive strand RNA virus populations are a collection of similar but genetically different viruses. They exist as viral quasispecies due to the high mutation rates of the low fidelity viral RNA-dependent RNA polymerase (RdRp). It is thought that this genomic heterogeneity is advantageous to the population, allowing for adaptation to rapidly changing environments that present varying types and degrees of selective pressure. However, one consequence of this extensive diversity is the susceptibility to mutagens that further increase sequence variation. Since RNA viruses live at the edge of maximal variability, an increase in the mutation rate is likely to force the virus beyond the tolerable mutation frequency into 'error catastrophe'. One such mutagen, ribavirin, is an antiviral nucleoside analog that is mutagenic to several RNA viruses. Ribavirin is incorporated into the viral genome causing lethal mutagenesis and a subsequent decrease in the specific infectivity. Even so, passaging poliovirus in the presence of low to intermediate concentrations of the drug leads to the emergence of a viral population resistant to the effects of ribavirin. These viruses have a point mutation in the RdRp that increases the overall polymerase fidelity. Interestingly, as predicted by the quasispecies theory, ribavirin resistant viruses are less adaptable, as they are more susceptible to other non-mutagenic antiviral drugs and are highly attenuated in vivo. Here, we review the mechanism of action of ribavirin on poliovirus and other RNA viruses, the possibility for escape via increased fidelity of the viral polymerase, the consequences of this response on viral population dynamics, and the biological implications for the therapeutic use of mutagenic antiviral agents.
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Affiliation(s)
- Marco Vignuzzi
- Department of Microbiology and Immunology, University of California, Mission Bay, Genentech Hall, Box 2280, San Francisco CA 94143-2280, USA
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Morrey JD, Day CW, Julander JG, Blatt LM, Smee DF, Sidwell RW. Effect of interferon-alpha and interferon-inducers on West Nile virus in mouse and hamster animal models. Antivir Chem Chemother 2004; 15:101-9. [PMID: 15185728 DOI: 10.1177/095632020401500202] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The recent West Nile virus (WNV) outbreak in the United States has increased the need to identify effective therapies. Studies were conducted in cell culture and in rodent animal models to determine the efficacy of interferon-alpha (IFN-alpha), interferon (IFN) inducers and ribavirin, alone or in combination with IFN, in treating WNV. Intraperitoneal injection of IFN-alpha B/D (qd for 7 days), polyI-polyC(12)U [Ampligen (every other day for 7 days)] and topically applied imiquimod (qd for 7 days), administered from 1 day before viral challenge, were effective in protecting, respectively, 100%, 100% and 70% of BALB/c mice from mortality induced by subcutaneous injection of WNV. When IFN-alpha B/D or Ampligen treatments were delayed to 4-6 h before viral challenge in mice, efficacy was greatly diminished. Infected Syrian golden hamsters treated with interferon alphacon-1 (Infergen) and Ampligen 4-6 h before viral challenge gained more weight and had a greater survival than saline-treated animals. A combination study of subcutaneously administered Infergen (5 to 0.05 microg/kg/day) and ribavirin (75 to 7.5 mg/kg/day) in >7 week old hamsters demonstrated that Infergen was slightly efficacious in reducing mortality and disease signs; however, it was not synergistic in its antiviral effects when combined with ribavirin. Ribavirin treatment alone increased mortality of infected hamsters. The reduced mortality correlated with reduced plasma viraemia. Since WNV-infected patients have already been treated with IFN and ribavirin and future clinical trials have been suggested, this first report of IFN alone or in combination with ribavirin in WNV-infected animal models might provide useful information for subsequent treatment of patients.
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Affiliation(s)
- John D Morrey
- Institute for Antiviral Research, Department of Animal, Dairy & Veterinary Sciences, Utah State University, Logan, UT, USA.
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Tepebaşili I, Caksen H, Odabaş D, Ataş B, Akbayram S. Report of two children with subacute sclerosing panencephalitis displaying an atypical clinical course1. J Emerg Med 2004; 26:356-9. [PMID: 15028344 DOI: 10.1016/j.jemermed.2003.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Tomoda A, Nomura K, Shiraishi S, Hamada A, Ohmura T, Hosoya M, Miike T, Sawaishi Y, Kimura H, Takashima H, Tohda Y, Mori K, Kato Z, Fukushima A, Nishio H, Nezu A, Nihei K. Trial of intraventricular ribavirin therapy for subacute sclerosing panencephalitis in Japan. Brain Dev 2003; 25:514-7. [PMID: 13129596 DOI: 10.1016/s0387-7604(03)00062-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ten patients with SSPE were surveyed during the last 4 years from the viewpoint of clinical safety for use of ribavirin therapy. Although effectiveness varied among cases, they were all treated safely with intraventricular ribavirin. This study suggests that treatment is safe and well-tolerated.
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Affiliation(s)
- Akemi Tomoda
- Department of Child Development, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-0811, Japan.
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Hara S, Kimura H, Hoshino Y, Hayashi N, Negoro T, Okumura A, Kajita Y, Sakuma T, Nakayama T, Hosoya M, Tomoda A, Morisima T. Combination therapy with intraventricular interferon-alpha and ribavirin for subacute sclerosing panencephalitis and monitoring measles virus RNA by quantitative PCR assay. Brain Dev 2003; 25:367-9. [PMID: 12850518 DOI: 10.1016/s0387-7604(03)00017-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a degenerative disease of the central nervous system that leads to death within a few years. Recently, it has been reported that combination therapy with intraparenchymal interferon-alpha (INF-alpha) and intraventricular ribavirin is effective. An 11-year-old SSPE patient whose clinical symptoms progressed rapidly, was treated first with intraventricular INF-alpha and then with combined intraventricular INF-alpha and ribavirin therapy. To monitor viral load over the course of the therapy, measles virus RNA was quantified using a real-time polymerase chain reaction assay. Measles virus RNA decreased rapidly after the INF-alpha therapy was started, paralleling the decrease in the measles antibody titer in the cerebrospinal fluid and the improvement in the neurological disability. After intraventricular ribavirin was combined with INF-alpha therapy, no further improvement was observed. The neurological disability gradually progressed, although the amount of virus RNA remained low.
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Affiliation(s)
- Shinya Hara
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Aydin OF, Senbil N, Kuyucu N, Gürer YKY. Combined treatment with subcutaneous interferon-alpha, oral isoprinosine, and lamivudine for subacute sclerosing panencephalitis. J Child Neurol 2003; 18:104-8. [PMID: 12693776 DOI: 10.1177/08830738030180020701] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared patients with subacute sclerosing panencephalitis who received treatment according to our protocol for at least 6 months (19 patients) with the patients who could not receive any treatment (13 patients). The treatment protocol consisted of oral isoprinosine (100 mg/kg/day), subcutaneous interferon alpha-2a (10 mU/m2/three times a week), and oral lamivudine (10 mg/kg/day). There were no statistical differences between the two groups according to Neurological Deficit Index, clinical stage, and average age on admission and also on the final evaluation after treatment. The mortality rates of both groups were similar: 3 (15.7%) for the treatment group and 6 (46%) for controls. The remission rates for the treatment and control groups were 7 of 19 (36.8%) and 0 of 13 (0%), respectively, and the difference was statistically significant (P = .036). The mean survival period of the treatment group was significantly longer than that of the control group (P = .01). In conclusion, this combination treatment protocol resulted in higher remission rates and longer survival periods when compared with controls, as well as a remission rate that was better than the spontaneous remission rate of 5%. For this reason, and as well as because interferon-alpha therapy has an easier route of application and a higher family compliance, we have considered this an alternative protocol for patients with subacute sclerosing panencephalitis.
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Affiliation(s)
- Omer Faruk Aydin
- Department of Pediatric Neurology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey.
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Solomon T, Hart CA, Vinjamuri S, Beeching NJ, Malucci C, Humphrey P. Treatment of subacute sclerosing panencephalitis with interferon-alpha, ribavirin, and inosiplex. J Child Neurol 2002; 17:703-5. [PMID: 12503650 DOI: 10.1177/088307380201700911] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subacute sclerosing panencephalitis is an almost universally fatal late complication of measles infection for which there is no established treatment. We report a patient with subacute sclerosing panencephalitis who was bed-bound and ataxic and had a left hemiparesis and frequent myoclonus. He was started on a new regimen consisting of intraventricular interferon-alpha (starting at 100,000 U/m2/day, building up to 1 million U/m2/day), ribavirin (60 mg/kg/day intravenously), and inosiplex (3 g/day) and improved markedly. At 10 weeks, the intraventricular reservoir was removed because of bacterial infection, and he was discharged home on oral ribavirin (1200 mg/kg/day) and inosiplex. He continued to improve as judged by neurologic examination, functional independence measurement, neuropsychometry and single photon emission computed tomography (SPECT) imaging. However, after 10 months, he deteriorated suddenly and died before further intraventricular treatment could be instituted. Further trials are needed to evaluate long-term combination therapy in subacute sclerosing panencephalitis.
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Affiliation(s)
- Tom Solomon
- Department of Neurological Science, University of Liverpool, United Kingdom.
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Hosoya M, Shigeta S, Mori S, Tomoda A, Shiraishi S, Miike T, Suzuki H. High-dose intravenous ribavirin therapy for subacute sclerosing panencephalitis. Antimicrob Agents Chemother 2001; 45:943-5. [PMID: 11181386 PMCID: PMC90399 DOI: 10.1128/aac.45.3.943-945.2001] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two patients with subacute sclerosing panencephalitis (SSPE) were treated safely and effectively with high doses of intravenous ribavirin combined with intraventricular alpha interferon. The ribavirin concentrations maintained in the serum and cerebrospinal fluid were higher than those which inhibit SSPE virus replication in vitro and in vivo.
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Affiliation(s)
- M Hosoya
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Japan.
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Tomoda A, Shiraishi S, Hosoya M, Hamada A, Miike T. Combined treatment with interferon-alpha and ribavirin for subacute sclerosing panencephalitis. Pediatr Neurol 2001; 24:54-9. [PMID: 11182282 DOI: 10.1016/s0887-8994(00)00233-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two patients with subacute sclerosing panencephalitis (SSPE) are described. They were diagnosed on admission to the hospital with SSPE, as judged on cerebrospinal fluid examination involving reverse transcription followed by polymerase chain reaction, at the second stage of Jabbour's classification. They first were treated with intraventricular interferon-alpha monotherapy; however, the combination of interferon-alpha and IV ribavirin was started at 8 and 5 months after beginning the interferon-alpha monotherapy, respectively. Although slow progressive brain atrophy was observed in Patient 1 on brain magnetic resonance imaging before the ribavirin therapy, no further progression was noted 11 months after starting combination therapy with ribavirin. The event-related potential study results and audiography of the right ear improved in Patient 1 after the combination therapy was initiated. In Patient 2 the hypertonicity, neurobladder incontinence, and dysphagia improved 3 months after starting the combination treatment. Although this group of patients is small, these results suggest treatment with intrathecal high-dose interferon-alpha and IV ribavirin is effective in the treatment of SSPE. Early administration of intrathecal high-dose interferon-alpha and IV ribavirin should be considered as a possible therapy for SSPE patients, especially interferon-nonresponding ones.
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Affiliation(s)
- A Tomoda
- Department of Child Development, Kumamoto University School of Medicine, Kumamoto, Japan
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Munoz FM. Antiviral agents in the critically ill child. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2000; 11:35-42. [PMID: 32336897 PMCID: PMC7173155 DOI: 10.1053/spid.0110035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment for most viral infections in children primarily is supportive. Severe viral illnesses and significant secondary complications that require treatment in the intensive care unit may occur in immunocompromised patients and also in infants and children who were previously healthy. Antiviral agents with specific activity against certain respiratory viruses, herpesviruses, and enteric viruses are available. New drugs are under development, and their use in pediatric patients is a subject of active research. The clinician's knowledge of the mechanisms of action, spectrum of activity, and side effects of these drugs is an important tool for their judicious use in the treatment of the critically ill child. Copyright © 2000 by W.B. Saunders Company
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19
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Lemon SM. Current status of antiviral therapy for chronic hepatitis C. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1999; 458:29-37. [PMID: 10549377 DOI: 10.1007/978-1-4615-4743-3_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- S M Lemon
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston 77555-1019, USA
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